{ "calculate_sdes": null, "calculation_method": "PATIENT", "cms_id": "CMS134v6", "component": false, "component_hqmf_set_ids": [ ], "composite": false, "composite_hqmf_set_id": null, "cql_libraries": [ { "cql": "library DiabetesMedicalAttentionforNephropathy version '6.1.003'\r\n\r\nusing QDM version '5.3'\r\n\r\ninclude Hospice version '0.1.000' called Hospice\r\ninclude MATGlobalCommonFunctions version '1.0.000' called Global\r\n\r\nvalueset \"ONC Administrative Sex\": 'urn:oid:2.16.840.1.113762.1.4.1'\r\nvalueset \"Race\": 'urn:oid:2.16.840.1.114222.4.11.836'\r\nvalueset \"Ethnicity\": 'urn:oid:2.16.840.1.114222.4.11.837'\r\nvalueset \"Payer\": 'urn:oid:2.16.840.1.114222.4.11.3591'\r\nvalueset \"ACE Inhibitor or ARB\": 'urn:oid:2.16.840.1.113883.3.526.3.1139'\r\nvalueset \"Annual Wellness Visit\": 'urn:oid:2.16.840.1.113883.3.526.3.1240'\r\nvalueset \"Diabetes\": 'urn:oid:2.16.840.1.113883.3.464.1003.103.12.1001'\r\nvalueset \"Diabetic Nephropathy\": 'urn:oid:2.16.840.1.113883.3.464.1003.109.12.1004'\r\nvalueset \"Dialysis Education\": 'urn:oid:2.16.840.1.113883.3.464.1003.109.12.1016'\r\nvalueset \"Dialysis Services\": 'urn:oid:2.16.840.1.113883.3.464.1003.109.12.1013'\r\nvalueset \"ESRD Monthly Outpatient Services\": 'urn:oid:2.16.840.1.113883.3.464.1003.109.12.1014'\r\nvalueset \"Face-to-Face Interaction\": 'urn:oid:2.16.840.1.113883.3.464.1003.101.12.1048'\r\nvalueset \"Glomerulonephritis and Nephrotic Syndrome\": 'urn:oid:2.16.840.1.113883.3.464.1003.109.12.1018'\r\nvalueset \"Home Healthcare Services\": 'urn:oid:2.16.840.1.113883.3.464.1003.101.12.1016'\r\nvalueset \"Hypertensive Chronic Kidney Disease\": 'urn:oid:2.16.840.1.113883.3.464.1003.109.12.1017'\r\nvalueset \"Kidney Transplant\": 'urn:oid:2.16.840.1.113883.3.464.1003.109.12.1012'\r\nvalueset \"Office Visit\": 'urn:oid:2.16.840.1.113883.3.464.1003.101.12.1001'\r\nvalueset \"Other Services Related to Dialysis\": 'urn:oid:2.16.840.1.113883.3.464.1003.109.12.1015'\r\nvalueset \"Preventive Care Services - Established Office Visit, 18 and Up\": 'urn:oid:2.16.840.1.113883.3.464.1003.101.12.1025'\r\nvalueset \"Preventive Care Services-Initial Office Visit, 18 and Up\": 'urn:oid:2.16.840.1.113883.3.464.1003.101.12.1023'\r\nvalueset \"Proteinuria\": 'urn:oid:2.16.840.1.113883.3.526.3.1003'\r\nvalueset \"Urine Protein Tests\": 'urn:oid:2.16.840.1.113883.3.464.1003.109.12.1024'\r\nvalueset \"Vascular Access for Dialysis\": 'urn:oid:2.16.840.1.113883.3.464.1003.109.12.1011'\r\nvalueset \"Kidney Failure\": 'urn:oid:2.16.840.1.113883.3.464.1003.109.12.1028'\r\n\r\nparameter \"Measurement Period\" Interval\r\n\r\ncontext Patient\r\n\r\ndefine \"SDE Ethnicity\":\r\n\t[\"Patient Characteristic Ethnicity\": \"Ethnicity\"]\r\n\r\ndefine \"SDE Payer\":\r\n\t[\"Patient Characteristic Payer\": \"Payer\"]\r\n\r\ndefine \"SDE Race\":\r\n\t[\"Patient Characteristic Race\": \"Race\"]\r\n\r\ndefine \"SDE Sex\":\r\n\t[\"Patient Characteristic Sex\": \"ONC Administrative Sex\"]\r\n\r\ndefine \"Renal Procedures\":\r\n\t( [\"Procedure, Performed\": \"Kidney Transplant\"]\r\n\t\t\tunion [\"Procedure, Performed\": \"Vascular Access for Dialysis\"]\r\n\t\t\tunion [\"Procedure, Performed\": \"Dialysis Services\"]\r\n\t)\r\n\r\ndefine \"Renal Interventions\":\r\n\t[\"Intervention, Performed\": \"Other Services Related to Dialysis\"]\r\n\t\tunion [\"Intervention, Performed\": \"Dialysis Education\"]\r\n\r\ndefine \"Qualifying Encounters\":\r\n\t( [\"Encounter, Performed\": \"Office Visit\"]\r\n\t\tunion [\"Encounter, Performed\": \"Face-to-Face Interaction\"]\r\n\t\tunion [\"Encounter, Performed\": \"Preventive Care Services - Established Office Visit, 18 and Up\"]\r\n\t\tunion [\"Encounter, Performed\": \"Preventive Care Services-Initial Office Visit, 18 and Up\"]\r\n\t\tunion [\"Encounter, Performed\": \"Home Healthcare Services\"]\r\n\t\tunion [\"Encounter, Performed\": \"Annual Wellness Visit\"] ) ValidEncounter\r\n\t\twhere ValidEncounter.relevantPeriod during \"Measurement Period\"\r\n\r\ndefine \"Protein Urea Lab Test\":\r\n\t[\"Laboratory Test, Performed\": \"Urine Protein Tests\"] ProteinUrea\r\n\t\twhere ProteinUrea.result is not null\r\n\r\ndefine \"Nephropathy Diagnoses\":\r\n\t( [\"Diagnosis\": \"Hypertensive Chronic Kidney Disease\"]\r\n\t\tunion [\"Diagnosis\": \"Kidney Failure\"]\r\n\t\tunion [\"Diagnosis\": \"Glomerulonephritis and Nephrotic Syndrome\"]\r\n\t\tunion [\"Diagnosis\": \"Diabetic Nephropathy\"]\r\n\t\tunion [\"Diagnosis\": \"Proteinuria\"] ) NephropathyDiagnoses\r\n\t\twhere NephropathyDiagnoses.prevalencePeriod overlaps \"Measurement Period\"\r\n\r\ndefine \"ESRD Encounter\":\r\n\t[\"Encounter, Performed\": \"ESRD Monthly Outpatient Services\"]\r\n\r\ndefine \"Active ACEI or ARB Medications\":\r\n\t[\"Medication, Active\": \"ACE Inhibitor or ARB\"] ACEIorARB\r\n\t\twhere ACEIorARB.relevantPeriod overlaps \"Measurement Period\"\r\n\r\ndefine \"Initial Population\":\r\n\texists [\"Patient Characteristic Birthdate\"] BirthDate\r\n\t\twhere Global.\"CalendarAgeInYearsAt\"(BirthDate.birthDatetime, start of \"Measurement Period\")>= 18\r\n\t\t\tand Global.\"CalendarAgeInYearsAt\"(BirthDate.birthDatetime, start of \"Measurement Period\")< 75\r\n\t\t\tand exists ( \"Qualifying Encounters\" )\r\n\t\t\tand exists ( [\"Diagnosis\": \"Diabetes\"] DiabetesDx\r\n\t\t\t\t\twhere DiabetesDx.prevalencePeriod overlaps \"Measurement Period\"\r\n\t\t\t)\r\n\r\ndefine \"Denominator\":\r\n\t\"Initial Population\"\r\n\r\ndefine \"Numerator\":\r\n\texists ( \"Active ACEI or ARB Medications\" )\r\n\t\tor exists ( \"Nephropathy Diagnoses\" )\r\n\t\tor exists ( \"Nephropathy Screenings\" )\r\n\r\ndefine \"In Hospice\":\r\n\tHospice.\"Has Hospice\"\r\n\r\ndefine \"Denominator Exclusions\":\r\n\t\"In Hospice\"\r\n\r\ndefine \"Nephropathy Screenings\":\r\n\t( \"Renal Procedures\"\r\n\t\tunion \"Renal Interventions\"\r\n\t\tunion \"ESRD Encounter\"\r\n\t\tunion \"Protein Urea Lab Test\" ) NephropathyScreenings\r\n\t\twhere NephropathyScreenings.relevantPeriod during \"Measurement Period\"\r\n", "elm": { "library": { "identifier": { "id": "DiabetesMedicalAttentionforNephropathy", "version": "6.1.003" }, "schemaIdentifier": { "id": "urn:hl7-org:elm", "version": "r1" }, "usings": { "def": [ { "localIdentifier": "System", "uri": "urn:hl7-org:elm-types:r1" }, { "localId": "1", "locator": "3:1-3:23", "localIdentifier": "QDM", "uri": "urn:healthit-gov:qdm:v5_3", "version": "5.3" } ] }, "includes": { "def": [ { "localId": "2", "locator": "5:1-5:48", "localIdentifier": "Hospice", "path": "Hospice", "version": "0.1.000" }, { "localId": "3", "locator": "7:1-7:64", "localIdentifier": "Global", "path": "MATGlobalCommonFunctions", "version": "1.0.000" } ] }, "parameters": { "def": [ { "localId": "30", "locator": "36:1-36:49", "name": "Measurement Period", "accessLevel": "Public", "parameterTypeSpecifier": { "localId": "29", "locator": "36:32-36:49", "type": "IntervalTypeSpecifier", "pointType": { "localId": "28", "locator": "36:41-36:48", "name": "{urn:hl7-org:elm-types:r1}DateTime", "type": "NamedTypeSpecifier" } } } ] }, "valueSets": { "def": [ { "localId": "4", "locator": "10:1-10:68", "name": "ONC Administrative Sex", "id": "2.16.840.1.113762.1.4.1", "accessLevel": "Public" }, { "localId": "5", "locator": "11:1-11:53", "name": "Race", "id": "2.16.840.1.114222.4.11.836", "accessLevel": "Public" }, { "localId": "6", "locator": "12:1-12:58", "name": "Ethnicity", "id": "2.16.840.1.114222.4.11.837", "accessLevel": "Public" }, { "localId": "7", "locator": "13:1-13:55", "name": "Payer", "id": "2.16.840.1.114222.4.11.3591", "accessLevel": "Public" }, { "localId": "8", "locator": "14:1-14:73", "name": "ACE Inhibitor or ARB", "id": "2.16.840.1.113883.3.526.3.1139", "accessLevel": "Public" }, { "localId": "9", "locator": "15:1-15:74", "name": "Annual Wellness Visit", "id": "2.16.840.1.113883.3.526.3.1240", "accessLevel": "Public" }, { "localId": "10", "locator": "16:1-16:71", "name": "Diabetes", "id": "2.16.840.1.113883.3.464.1003.103.12.1001", "accessLevel": "Public" }, { "localId": "11", "locator": "17:1-17:83", "name": "Diabetic Nephropathy", "id": "2.16.840.1.113883.3.464.1003.109.12.1004", "accessLevel": "Public" }, { "localId": "12", "locator": "18:1-18:81", "name": "Dialysis Education", "id": "2.16.840.1.113883.3.464.1003.109.12.1016", "accessLevel": "Public" }, { "localId": "13", "locator": "19:1-19:80", "name": "Dialysis Services", "id": "2.16.840.1.113883.3.464.1003.109.12.1013", "accessLevel": "Public" }, { "localId": "14", "locator": "20:1-20:95", "name": "ESRD Monthly Outpatient Services", "id": "2.16.840.1.113883.3.464.1003.109.12.1014", "accessLevel": "Public" }, { "localId": "15", "locator": "21:1-21:87", "name": "Face-to-Face Interaction", "id": "2.16.840.1.113883.3.464.1003.101.12.1048", "accessLevel": "Public" }, { "localId": "16", "locator": "22:1-22:104", "name": "Glomerulonephritis and Nephrotic Syndrome", "id": "2.16.840.1.113883.3.464.1003.109.12.1018", "accessLevel": "Public" }, { "localId": "17", "locator": "23:1-23:87", "name": "Home Healthcare Services", "id": "2.16.840.1.113883.3.464.1003.101.12.1016", "accessLevel": "Public" }, { "localId": "18", "locator": "24:1-24:98", "name": "Hypertensive Chronic Kidney Disease", "id": "2.16.840.1.113883.3.464.1003.109.12.1017", "accessLevel": "Public" }, { "localId": "19", "locator": "25:1-25:80", "name": "Kidney Transplant", "id": "2.16.840.1.113883.3.464.1003.109.12.1012", "accessLevel": "Public" }, { "localId": "20", "locator": "26:1-26:75", "name": "Office Visit", "id": "2.16.840.1.113883.3.464.1003.101.12.1001", "accessLevel": "Public" }, { "localId": "21", "locator": "27:1-27:97", "name": "Other Services Related to Dialysis", "id": "2.16.840.1.113883.3.464.1003.109.12.1015", "accessLevel": "Public" }, { "localId": "22", "locator": "28:1-28:125", "name": "Preventive Care Services - Established Office Visit, 18 and Up", "id": "2.16.840.1.113883.3.464.1003.101.12.1025", "accessLevel": "Public" }, { "localId": "23", "locator": "29:1-29:119", "name": "Preventive Care Services-Initial Office Visit, 18 and Up", "id": "2.16.840.1.113883.3.464.1003.101.12.1023", "accessLevel": "Public" }, { "localId": "24", "locator": "30:1-30:64", "name": "Proteinuria", "id": "2.16.840.1.113883.3.526.3.1003", "accessLevel": "Public" }, { "localId": "25", "locator": "31:1-31:82", "name": "Urine Protein Tests", "id": "2.16.840.1.113883.3.464.1003.109.12.1024", "accessLevel": "Public" }, { "localId": "26", "locator": "32:1-32:91", "name": "Vascular Access for Dialysis", "id": "2.16.840.1.113883.3.464.1003.109.12.1011", "accessLevel": "Public" }, { "localId": "27", "locator": "33:1-33:77", "name": "Kidney Failure", "id": "2.16.840.1.113883.3.464.1003.109.12.1028", "accessLevel": "Public" } ] }, "statements": { "def": [ { "locator": "38:1-38:15", "name": "Patient", "context": "Patient", "expression": { "type": "SingletonFrom", "operand": { "locator": "38:1-38:15", "dataType": "{urn:healthit-gov:qdm:v5_3}Patient", "templateId": "Patient", "type": "Retrieve" } } }, { "localId": "32", "locator": "40:1-41:50", "name": "SDE Ethnicity", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "32", "s": [ { "value": [ "define ", "\"SDE Ethnicity\"", ":\n\t" ] }, { "r": "31", "s": [ { "value": [ "[", "\"Patient Characteristic Ethnicity\"", ": " ] }, { "s": [ { "value": [ "\"Ethnicity\"" ] } ] }, { "value": [ "]" ] } ] } ] } } ], "expression": { "localId": "31", "locator": "41:2-41:50", "dataType": "{urn:healthit-gov:qdm:v5_3}PatientCharacteristicEthnicity", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Ethnicity", "type": "ValueSetRef" } } }, { "localId": "34", "locator": "43:1-44:42", "name": "SDE Payer", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "34", "s": [ { "value": [ "define ", "\"SDE Payer\"", ":\n\t" ] }, { "r": "33", "s": [ { "value": [ "[", "\"Patient Characteristic Payer\"", ": " ] }, { "s": [ { "value": [ "\"Payer\"" ] } ] }, { "value": [ "]" ] } ] } ] } } ], "expression": { "localId": "33", "locator": "44:2-44:42", "dataType": "{urn:healthit-gov:qdm:v5_3}PatientCharacteristicPayer", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Payer", "type": "ValueSetRef" } } }, { "localId": "36", "locator": "46:1-47:40", "name": "SDE Race", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "36", "s": [ { "value": [ "define ", "\"SDE Race\"", ":\n\t" ] }, { "r": "35", "s": [ { "value": [ "[", "\"Patient Characteristic Race\"", ": " ] }, { "s": [ { "value": [ "\"Race\"" ] } ] }, { "value": [ "]" ] } ] } ] } } ], "expression": { "localId": "35", "locator": "47:2-47:40", "dataType": "{urn:healthit-gov:qdm:v5_3}PatientCharacteristicRace", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Race", "type": "ValueSetRef" } } }, { "localId": "38", "locator": "49:1-50:57", "name": "SDE Sex", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "38", "s": [ { "value": [ "define ", "\"SDE Sex\"", ":\n\t" ] }, { "r": "37", "s": [ { "value": [ "[", "\"Patient Characteristic Sex\"", ": " ] }, { "s": [ { "value": [ "\"ONC Administrative Sex\"" ] } ] }, { "value": [ "]" ] } ] } ] } } ], "expression": { "localId": "37", "locator": "50:2-50:57", "dataType": "{urn:healthit-gov:qdm:v5_3}PatientCharacteristicSex", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "ONC Administrative Sex", "type": "ValueSetRef" } } }, { "localId": "44", "locator": "52:1-56:2", "name": "Renal Procedures", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "44", "s": [ { "value": [ "define ", "\"Renal Procedures\"", ":\n\t" ] }, { "r": "43", "s": [ { "value": [ "( " ] }, { "r": "43", "s": [ { "r": "41", "s": [ { "r": "39", "s": [ { "value": [ "[", "\"Procedure, Performed\"", ": " ] }, { "s": [ { "value": [ "\"Kidney Transplant\"" ] } ] }, { "value": [ "]" ] } ] }, { "value": [ "\n\t\t\tunion " ] }, { "r": "40", "s": [ { "value": [ "[", "\"Procedure, Performed\"", ": " ] }, { "s": [ { "value": [ "\"Vascular Access for Dialysis\"" ] } ] }, { "value": [ "]" ] } ] } ] }, { "value": [ "\n\t\t\tunion " ] }, { "r": "42", "s": [ { "value": [ "[", "\"Procedure, Performed\"", ": " ] }, { "s": [ { "value": [ "\"Dialysis Services\"" ] } ] }, { "value": [ "]" ] } ] } ] }, { "value": [ "\n\t)" ] } ] } ] } } ], "expression": { "localId": "43", "locator": "53:2-56:2", "type": "Union", "operand": [ { "localId": "41", "locator": "53:4-54:65", "type": "Union", "operand": [ { "localId": "39", "locator": "53:4-53:48", "dataType": "{urn:healthit-gov:qdm:v5_3}PositiveProcedurePerformed", "templateId": "PositiveProcedurePerformed", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Kidney Transplant", "type": "ValueSetRef" } }, { "localId": "40", "locator": "54:10-54:65", "dataType": "{urn:healthit-gov:qdm:v5_3}PositiveProcedurePerformed", "templateId": "PositiveProcedurePerformed", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Vascular Access for Dialysis", "type": "ValueSetRef" } } ] }, { "localId": "42", "locator": "55:10-55:54", "dataType": "{urn:healthit-gov:qdm:v5_3}PositiveProcedurePerformed", "templateId": "PositiveProcedurePerformed", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Dialysis Services", "type": "ValueSetRef" } } ] } }, { "localId": "48", "locator": "58:1-60:57", "name": "Renal Interventions", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "48", "s": [ { "value": [ "define ", "\"Renal Interventions\"", ":\n\t" ] }, { "r": "47", "s": [ { "r": "45", "s": [ { "value": [ "[", "\"Intervention, Performed\"", ": " ] }, { "s": [ { "value": [ "\"Other Services Related to Dialysis\"" ] } ] }, { "value": [ "]" ] } ] }, { "value": [ "\n\t\tunion " ] }, { "r": "46", "s": [ { "value": [ "[", "\"Intervention, Performed\"", ": " ] }, { "s": [ { "value": [ "\"Dialysis Education\"" ] } ] }, { "value": [ "]" ] } ] } ] } ] } } ], "expression": { "localId": "47", "locator": "59:2-60:57", "type": "Union", "operand": [ { "localId": "45", "locator": "59:2-59:66", "dataType": "{urn:healthit-gov:qdm:v5_3}PositiveInterventionPerformed", "templateId": "PositiveInterventionPerformed", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Other Services Related to Dialysis", "type": "ValueSetRef" } }, { "localId": "46", "locator": "60:9-60:57", "dataType": "{urn:healthit-gov:qdm:v5_3}PositiveInterventionPerformed", "templateId": "PositiveInterventionPerformed", "codeProperty": "code", "type": "Retrieve", "codes": { "name": "Dialysis Education", "type": "ValueSetRef" } } ] } }, { "localId": "66", "locator": "62:1-69:65", "name": "Qualifying Encounters", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "66", "s": [ { "value": [ "define ", "\"Qualifying Encounters\"", ":\n\t" ] }, { "r": "65", "s": [ { "s": [ { "r": "60", "s": [ { "r": "59", "s": [ { "value": [ "( " ] }, { "r": "59", "s": [ { "r": "57", "s": [ { "r": "55", "s": [ { "r": "53", "s": [ { "r": "51", "s": [ { "r": "49", "s": [ { "value": [ "[", "\"Encounter, Performed\"", ": " ] }, { "s": [ { "value": [ "\"Office Visit\"" ] } ] }, { "value": [ "]" ] } ] }, { "value": [ "\n\t\tunion " ] }, { "r": "50", "s": [ { "value": [ "[", "\"Encounter, Performed\"", ": " ] }, { "s": [ { "value": [ "\"Face-to-Face Interaction\"" ] } ] }, { "value": [ "]" ] } ] } ] }, { "value": [ "\n\t\tunion " ] }, { "r": "52", "s": [ { "value": [ "[", "\"Encounter, Performed\"", ": " ] }, { "s": [ { "value": [ "\"Preventive Care Services - Established Office Visit, 18 and Up\"" ] } ] }, { "value": [ "]" ] } ] } ] }, { "value": [ 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"library_version": "6.1.003", "statement_dependencies": [ { "statement_name": "Patient" }, { "statement_name": "SDE Ethnicity" }, { "statement_name": "SDE Payer" }, { "statement_name": "SDE Race" }, { "statement_name": "SDE Sex" }, { "statement_name": "Renal Procedures" }, { "statement_name": "Renal Interventions" }, { "statement_name": "Qualifying Encounters" }, { "statement_name": "Protein Urea Lab Test" }, { "statement_name": "Nephropathy Diagnoses" }, { "statement_name": "ESRD Encounter" }, { "statement_name": "Active ACEI or ARB Medications" }, { "statement_name": "Initial Population", "statement_references": [ { "hqmf_id": null, "library_name": "MATGlobalCommonFunctions", "statement_name": "CalendarAgeInYearsAt" }, { "hqmf_id": null, "library_name": "MATGlobalCommonFunctions", "statement_name": "CalendarAgeInYearsAt" }, { "hqmf_id": null, "library_name": "DiabetesMedicalAttentionforNephropathy", "statement_name": "Qualifying Encounters" } ] }, { "statement_name": "Denominator", "statement_references": [ { "hqmf_id": null, "library_name": "DiabetesMedicalAttentionforNephropathy", "statement_name": "Initial Population" } ] }, { "statement_name": "Nephropathy Screenings", "statement_references": [ { "hqmf_id": null, "library_name": "DiabetesMedicalAttentionforNephropathy", "statement_name": "Renal Procedures" }, { "hqmf_id": null, "library_name": "DiabetesMedicalAttentionforNephropathy", "statement_name": "Renal Interventions" }, { "hqmf_id": null, "library_name": "DiabetesMedicalAttentionforNephropathy", "statement_name": "ESRD Encounter" }, { "hqmf_id": null, "library_name": "DiabetesMedicalAttentionforNephropathy", "statement_name": "Protein Urea Lab Test" } ] }, { "statement_name": "Numerator", "statement_references": [ { "hqmf_id": null, "library_name": "DiabetesMedicalAttentionforNephropathy", "statement_name": "Active ACEI or ARB Medications" }, { "hqmf_id": null, "library_name": "DiabetesMedicalAttentionforNephropathy", "statement_name": "Nephropathy Diagnoses" }, { "hqmf_id": null, "library_name": "DiabetesMedicalAttentionforNephropathy", "statement_name": "Nephropathy Screenings" } ] }, { "statement_name": "In Hospice", "statement_references": [ { "hqmf_id": null, "library_name": "Hospice", "statement_name": "Has Hospice" } ] }, { "statement_name": "Denominator Exclusions", "statement_references": [ { "hqmf_id": null, "library_name": "DiabetesMedicalAttentionforNephropathy", "statement_name": "In Hospice" } ] } ] }, { "cql": "library MATGlobalCommonFunctions version '1.0.000'\r\n\r\nusing QDM version '5.3'\r\n\r\ncodesystem \"LOINC:2.46\": 'urn:oid:2.16.840.1.113883.6.1' version 'urn:hl7:version:2.46'\r\ncodesystem \"SNOMEDCT:2016-03\": 'urn:oid:2.16.840.1.113883.6.96' version 'urn:hl7:version:2016-03'\r\n\r\nvalueset \"Emergency Department Visit\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.292'\r\n\r\ncode \"Birthdate\": '21112-8' from \"LOINC:2.46\" display 'Birth date'\r\ncode \"Dead\": '419099009' from \"SNOMEDCT:2016-03\" display 'Dead'\r\n\r\nparameter \"Measurement Period\" Interval\r\n\r\ncontext Patient\n\n/*ToDate takes a given DateTime value and returns a DateTime with the time components \"zeroed\", and the timezone of the input value, for example, given the DateTime @2012-01-01T06:30:00.0Z, this function will return @2012-01-01T00:00:00.0Z.*/\r\n\r\ndefine function \"ToDate\"(Value DateTime):\r\n\tDateTime(year from Value, month from Value, day from Value, 0, 0, 0, 0, timezone from Value)\n\n/*CalendarAgeInDaysAt calculates the calendar age (meaning the age without considering time components) in days.*/\r\n\r\ndefine function \"CalendarAgeInDaysAt\"(BirthDateTime DateTime, AsOf DateTime):\r\n\tdays between ToDate(BirthDateTime)and ToDate(AsOf)\n\n/*CalendarAgeInDays calculates the calendar age (meaning the age without considering time components) in days as of today*/\r\n\r\ndefine function \"CalendarAgeInDays\"(BirthDateTime DateTime):\r\n\tCalendarAgeInDaysAt(BirthDateTime, Today())\n\n/*CalendarAgeInMonthsAt calculates the calendar age (meaning the age without considering time components) in months.*/\r\n\r\ndefine function \"CalendarAgeInMonthsAt\"(BirthDateTime DateTime, AsOf DateTime):\r\n\tmonths between ToDate(BirthDateTime)and ToDate(AsOf)\n\n/*CalendarAgeInMonths calculates the calendar age (meaning the age without considering time components) in months as of today.*/\r\n\r\ndefine function \"CalendarAgeInMonths\"(BirthDateTime DateTime):\r\n\tCalendarAgeInMonthsAt(BirthDateTime, Today())\n\n/*CalendarAgeInYearsAt calculates the calendar age (meaning the age without considering time components) in years.*/\r\n\r\ndefine function \"CalendarAgeInYearsAt\"(BirthDateTime DateTime, AsOf DateTime):\r\n\tyears between ToDate(BirthDateTime)and ToDate(AsOf)\n\n/*CalendarAgeInYears calculates the calendar age (meaning the age without considering time components) in years as of today.*/\r\n\r\ndefine function \"CalendarAgeInYears\"(BirthDateTime DateTime):\r\n\tCalendarAgeInYearsAt(BirthDateTime, Today())\n\n/*Hospitalization returns the total interval for admission to discharge for the given encounter, or for the admission of any immediately prior emergency department visit to the discharge of the given encounter.*/\r\n\r\ndefine function \"Hospitalization\"(Encounter \"Encounter, Performed\"):\r\n\t( singleton from ( [\"Encounter, Performed\": \"Emergency Department Visit\"] EDVisit\r\n\t\t\twhere EDVisit.relevantPeriod ends 1 hour or less on or before start of Encounter.relevantPeriod\r\n\t) ) X\r\n\t\treturn if X is null then Encounter.relevantPeriod else Interval[start of X.relevantPeriod, end of Encounter.relevantPeriod]\n\n/*calculates the difference in calendar days between the start and end of the given interval.*/\r\n\r\ndefine function \"LengthInDays\"(Value Interval):\r\n\tdifference in days between start of Value and end of Value\n\n/*TotalLengthOfStay calculates the difference in calendar days between the start and end of the given stay interval.*/\r\n\r\ndefine function \"TotalLengthOfStay\"(Stay Interval):\r\n\tdifference in days between start of Stay and end of Stay\r\n", "elm": { "library": { "identifier": { "id": "MATGlobalCommonFunctions", "version": "1.0.000" }, "schemaIdentifier": { "id": "urn:hl7-org:elm", "version": "r1" }, "usings": { "def": [ { "localIdentifier": "System", "uri": "urn:hl7-org:elm-types:r1" }, { "localId": "1", "locator": "3:1-3:23", "localIdentifier": "QDM", "uri": "urn:healthit-gov:qdm:v5_3", "version": "5.3" } ] }, "parameters": { "def": [ { "localId": "11", "locator": "13:1-13:49", "name": "Measurement Period", "accessLevel": "Public", "parameterTypeSpecifier": { "localId": "10", "locator": "13:32-13:49", "type": "IntervalTypeSpecifier", "pointType": { "localId": "9", "locator": "13:41-13:48", "name": "{urn:hl7-org:elm-types:r1}DateTime", "type": "NamedTypeSpecifier" } } } ] }, "codeSystems": { "def": [ { "localId": "2", "locator": "5:1-5:87", "name": 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} ] }, { "children": [ { "children": [ { "text": "end of " } ] }, { "children": [ { "children": [ { "children": [ { "text": "Encounter" } ] } ], "ref_id": "86" }, { "children": [ { "text": "." } ] }, { "children": [ { "children": [ { "text": "relevantPeriod" } ] } ], "node_type": "Property", "ref_id": "87" } ], "node_type": "Property", "ref_id": "87" } ], "ref_id": "88" }, { "children": [ { "text": "]" } ] } ], "ref_id": "89" } ], "node_type": "If", "ref_id": "90" } ], "ref_id": "91" } ], "node_type": "Query", "ref_id": "92" } ], "node_type": "Query", "ref_id": "92" } ], "ref_id": "93" } ], "define_name": "Hospitalization" }, { "children": [ { "children": [ { "children": [ { "text": "define function \"LengthInDays\"(Value " } ] }, { "children": [ { "children": [ { "text": "Interval<" } ] }, { "children": [ { "children": [ { "text": "DateTime" } ] } ], "ref_id": "94" }, { "children": [ { "text": ">" } ] } ], "ref_id": "95" }, { "children": [ { "text": " ):\n " } ] }, { "children": [ { "children": [ { "children": [ { "text": "difference in days between " } ] }, { "children": [ { "children": [ { "text": "start of " } ] }, { "children": [ { "children": [ { "text": "Value" } ] } ], "node_type": "OperandRef", "ref_id": "96" } ], "node_type": "Start", "ref_id": "97" }, { "children": [ { "text": " and " } ] }, { "children": [ { "children": [ { "text": "end of " } ] }, { "children": [ { "children": [ { "text": "Value" } ] } ], "node_type": "OperandRef", "ref_id": "98" } ], "node_type": "End", "ref_id": "99" } ], "node_type": "DifferenceBetween", "ref_id": "100" } ], "node_type": "DifferenceBetween", "ref_id": "100" } ], "ref_id": "101" } ], "define_name": "LengthInDays" }, { "children": [ { "children": [ { "children": [ { "text": "define function \"TotalLengthOfStay\"(Stay " } ] }, { "children": [ { "children": [ { "text": "Interval<" } ] }, { "children": [ { "children": [ { "text": "DateTime" } ] } ], "ref_id": "102" }, { "children": [ { "text": ">" } ] } ], "ref_id": "103" }, { "children": [ { "text": " ):\n " } ] }, { "children": [ { "children": [ { "children": [ { "text": "difference in days between " } ] }, { "children": [ { "children": [ { "text": "start of " } ] }, { "children": [ { "children": [ { "text": "Stay" } ] } ], "node_type": "OperandRef", "ref_id": "104" } ], "node_type": "Start", "ref_id": "105" }, { "children": [ { "text": " and " } ] }, { "children": [ { "children": [ { "text": "end of " } ] }, { "children": [ { "children": [ { "text": "Stay" } ] } ], "node_type": "OperandRef", "ref_id": "106" } ], "node_type": "End", "ref_id": "107" } ], "node_type": "DifferenceBetween", "ref_id": "108" } ], "node_type": "DifferenceBetween", "ref_id": "108" } ], "ref_id": "109" } ], "define_name": "TotalLengthOfStay" } ], "identifier": { "id": "MATGlobalCommonFunctions", "version": "1.0.000" } }, "is_main_library": false, "is_top_level": true, "library_name": "MATGlobalCommonFunctions", "library_version": "1.0.000", "statement_dependencies": [ { "statement_name": "CalendarAgeInYearsAt", "statement_references": [ { "hqmf_id": null, "library_name": "MATGlobalCommonFunctions", "statement_name": "ToDate" } ] }, { "statement_name": "ToDate" } ] }, { "cql": "library Hospice version '0.1.000'\r\n\r\nusing QDM version '5.3'\r\n\r\ncodesystem \"LOINC:2.46\": 'urn:oid:2.16.840.1.113883.6.1' version 'urn:hl7:version:2.46'\r\ncodesystem \"SNOMEDCT:2016-03\": 'urn:oid:2.16.840.1.113883.6.96' version 'urn:hl7:version:2016-03'\r\ncodesystem \"SNOMEDCT:2017-03\": 'urn:oid:2.16.840.1.113883.6.96' version 'urn:hl7:version:2017-03'\r\n\r\nvalueset \"Discharged to Health Care Facility for Hospice Care\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.207'\r\nvalueset \"Discharged to Home for Hospice Care\": 'urn:oid:2.16.840.1.113883.3.117.1.7.1.209'\r\nvalueset \"Encounter Inpatient\": 'urn:oid:2.16.840.1.113883.3.666.5.307'\r\nvalueset \"Hospice care ambulatory\": 'urn:oid:2.16.840.1.113762.1.4.1108.15'\r\n\r\ncode \"Birthdate\": '21112-8' from \"LOINC:2.46\" display 'Birth date'\r\ncode \"Dead\": '419099009' from \"SNOMEDCT:2016-03\" display 'Dead'\r\ncode \"Discharge to healthcare facility for hospice care (procedure)\": '428371000124100' from \"SNOMEDCT:2017-03\" display 'Discharge to healthcare facility for hospice care (procedure)'\r\ncode \"Discharge to home for hospice care (procedure)\": '428361000124107' from \"SNOMEDCT:2017-03\" display 'Discharge to home for hospice care (procedure)'\r\n\r\nparameter \"Measurement Period\" Interval\r\n\r\ncontext Patient\r\n\r\ndefine \"Has Hospice\":\r\n\texists ( [\"Encounter, Performed\": \"Encounter Inpatient\"] DischargeHospice\r\n\t\t\twhere ( DischargeHospice.dischargeDisposition as Code ~ \"Discharge to home for hospice care (procedure)\"\r\n\t\t\t\t\tor DischargeHospice.dischargeDisposition as Code ~ \"Discharge to healthcare facility for hospice care (procedure)\"\r\n\t\t\t)\r\n\t\t\t\tand DischargeHospice.relevantPeriod ends during \"Measurement Period\"\r\n\t)\r\n\t\tor exists ( [\"Intervention, Order\": \"Hospice care ambulatory\"] HospiceOrder\r\n\t\t\t\twhere HospiceOrder.authorDatetime during \"Measurement Period\"\r\n\t\t)\r\n\t\tor exists ( [\"Intervention, Performed\": \"Hospice care ambulatory\"] HospicePerformed\r\n\t\t\t\twhere HospicePerformed.relevantPeriod overlaps \"Measurement Period\"\r\n\t\t)\r\n", "elm": { "library": { "identifier": { "id": "Hospice", "version": "0.1.000" }, "schemaIdentifier": { "id": "urn:hl7-org:elm", "version": "r1" }, "usings": { "def": [ { "localIdentifier": "System", "uri": "urn:hl7-org:elm-types:r1" }, { "localId": "1", "locator": "3:1-3:23", "localIdentifier": "QDM", "uri": "urn:healthit-gov:qdm:v5_3", "version": "5.3" } ] }, "parameters": { "def": [ { "localId": "19", "locator": "19:1-19:49", "name": "Measurement Period", "accessLevel": "Public", "parameterTypeSpecifier": { "localId": "18", "locator": "19:32-19:49", "type": "IntervalTypeSpecifier", "pointType": { "localId": "17", "locator": "19:41-19:48", "name": "{urn:hl7-org:elm-types:r1}DateTime", "type": "NamedTypeSpecifier" } } } ] }, "codeSystems": { "def": [ { "localId": "2", "locator": "5:1-5:87", "name": "LOINC:2.46", "id": "2.16.840.1.113883.6.1", "version": "urn:hl7:version:2.46", "accessLevel": "Public" }, { "localId": "3", "locator": "6:1-6:97", "name": "SNOMEDCT:2016-03", "id": "2.16.840.1.113883.6.96", "version": "urn:hl7:version:2016-03", "accessLevel": "Public" }, { "localId": "4", "locator": "7:1-7:97", "name": "SNOMEDCT:2017-03", "id": "2.16.840.1.113883.6.96", "version": "urn:hl7:version:2017-03", "accessLevel": "Public" } ] }, "valueSets": { "def": [ { "localId": "5", "locator": "9:1-9:107", "name": "Discharged to Health Care Facility for Hospice Care", "id": "2.16.840.1.113883.3.117.1.7.1.207", "accessLevel": "Public" }, { "localId": "6", "locator": "10:1-10:91", "name": "Discharged to Home for Hospice Care", "id": "2.16.840.1.113883.3.117.1.7.1.209", "accessLevel": "Public" }, { "localId": "7", "locator": "11:1-11:71", "name": "Encounter Inpatient", "id": "2.16.840.1.113883.3.666.5.307", "accessLevel": "Public" }, { "localId": "8", "locator": "12:1-12:75", "name": "Hospice care ambulatory", "id": "2.16.840.1.113762.1.4.1108.15", "accessLevel": "Public" } ] }, "codes": { "def": [ { "localId": "10", "locator": "14:1-14:66", "name": "Birthdate", "id": "21112-8", "display": "Birth date", "accessLevel": "Public", "codeSystem": { "localId": "9", "locator": "14:34-14:45", "name": "LOINC:2.46" } }, { "localId": "12", "locator": "15:1-15:63", "name": "Dead", "id": "419099009", "display": "Dead", "accessLevel": "Public", "codeSystem": { "localId": "11", "locator": "15:31-15:48", "name": "SNOMEDCT:2016-03" } }, { "localId": "14", "locator": "16:1-16:183", "name": "Discharge to healthcare facility for hospice care (procedure)", "id": "428371000124100", "display": "Discharge to healthcare facility for hospice care (procedure)", "accessLevel": "Public", "codeSystem": { "localId": "13", "locator": "16:94-16:111", "name": "SNOMEDCT:2017-03" } }, { "localId": "16", "locator": "17:1-17:153", "name": "Discharge to home for hospice care (procedure)", "id": "428361000124107", "display": "Discharge to home for hospice care (procedure)", "accessLevel": "Public", "codeSystem": { "localId": "15", "locator": "17:79-17:96", "name": "SNOMEDCT:2017-03" } } ] }, "statements": { "def": [ { "locator": "21:1-21:15", "name": "Patient", "context": "Patient", "expression": { "type": "SingletonFrom", "operand": { "locator": "21:1-21:15", "dataType": "{urn:healthit-gov:qdm:v5_3}Patient", "templateId": "Patient", "type": "Retrieve" } } }, { "localId": "60", "locator": "23:1-35:3", "name": "Has Hospice", "context": "Patient", "accessLevel": "Public", "annotation": [ { "type": "Annotation", "s": { "r": "60", "s": [ { "value": [ "define ", "\"Has Hospice\"", ":\n\t" ] }, { "r": "59", "s": [ { "r": "50", "s": [ { "r": "41", "s": [ { "value": [ "exists " ] }, { "r": "40", "s": [ { "value": [ "( " ] }, { 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The Measure is copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses must be approved by NCQA and are subject to a license at the discretion of NCQA. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved. \n\nLimited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications.\n\nCPT(R) contained in the Measure specifications is copyright 2004-2016 American Medical Association. LOINC(R) copyright 2004-2016 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2016 International Health Terminology Standards Development Organisation. ICD-10 copyright 2016 World Health Organization. All Rights Reserved.\n\nThe American Hospital Association holds a copyright to the National Uniform Billing Committee (NUBC) codes contained in the measure specifications. The NUBC codes in the specifications are included with the permission of the AHA. The NUBC codes contained in the specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting Measure results or using Measure results for their internal quality improvement purposes. All other uses of the NUBC codes require a license from the AHA. Anyone desiring to use the NUBC codes in a commercial product to generate Measure results, or for any other commercial use, must obtain a commercial use license directly from the AHA. To inquire about licensing, contact ub04@healthforum.com.", "name": "Copyright", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "COPY", "title": "Copyright" }, "value_obj": { "type": "ED", "value": "This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). The Measure is copyrighted but can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses must be approved by NCQA and are subject to a license at the discretion of NCQA. NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved. \n\nLimited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications.\n\nCPT(R) contained in the Measure specifications is copyright 2004-2016 American Medical Association. LOINC(R) copyright 2004-2016 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2016 International Health Terminology Standards Development Organisation. ICD-10 copyright 2016 World Health Organization. All Rights Reserved.\n\nThe American Hospital Association holds a copyright to the National Uniform Billing Committee (NUBC) codes contained in the measure specifications. The NUBC codes in the specifications are included with the permission of the AHA. The NUBC codes contained in the specifications may be used by health plans and other health care delivery organizations for the purpose of calculating and reporting Measure results or using Measure results for their internal quality improvement purposes. All other uses of the NUBC codes require a license from the AHA. Anyone desiring to use the NUBC codes in a commercial product to generate Measure results, or for any other commercial use, must obtain a commercial use license directly from the AHA. To inquire about licensing, contact ub04@healthforum.com.", "media_type": "text/plain" } }, { "code": "DISC", "value": "The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.\n \nDue to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].", "name": "Disclaimer", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "DISC", "title": "Disclaimer" }, "value_obj": { "type": "ED", "value": "The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED \"AS IS\" WITHOUT WARRANTY OF ANY KIND.\n \nDue to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].", "media_type": "text/plain" } }, { "code": "MSRSCORE", "name": "Measure Scoring", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "MSRSCORE", "title": "Measure Scoring" }, "value_obj": { "type": "CD", "system": "2.16.840.1.113883.1.11.20367", "code": "PROPOR", "title": "Proportion" } }, { "code": "MSRTYPE", "name": "Measure Type", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "MSRTYPE", "title": "Measure Type" }, "value_obj": { "type": "CD", "system": "2.16.840.1.113883.1.11.20368", "code": "PROCESS", "title": "PROCESS" } }, { "code": "STRAT", "value": "None", "name": "Stratification", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "STRAT", "title": "Stratification" }, "value_obj": { "type": "ED", "value": "None", "media_type": "text/plain" } }, { "code": "MSRADJ", "value": "None", "name": "Risk Adjustment", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "MSRADJ", "title": "Risk Adjustment" }, "value_obj": { "type": "ED", "value": "None", "media_type": "text/plain" } }, { "code": "MSRAGG", "value": "None", "name": "Rate Aggregation", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "MSRAGG", "title": "Rate Aggregation" }, "value_obj": { "type": "ED", "value": "None", "media_type": "text/plain" } }, { "code": "RAT", "value": "As the seventh leading cause of death in the U.S., diabetes kills approximately 75,000 people a year (CDC FastStats 2015). Diabetes is a group of diseases marked by high blood glucose levels, resulting from the body's inability to produce or use insulin (CDC Statistics 2014, ADA Basics 2013). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney failure, amputation of toes, feet or legs, and premature death. (CDC Fact Sheet 2014). \n\nIn 2012, diabetes cost the U.S. an estimated $245 billion: $176 billion in direct medical costs and $69 billion in reduced productivity. This is a 41 percent increase from the estimated $174 billion spent on diabetes in 2007 (ADA Economic 2013). \n\nIn 2011, diabetes accounted for 44% of new kidney failure cases. In the same year, 49,677 diabetics started treatment for kidney failure and 228,924 people of all ages with kidney failure due to diabetes were living on chronic dialysis or with a kidney transplant (CDC Statistics, 2014).", "name": "Rationale", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "RAT", "title": "Rationale" }, "value_obj": { "type": "ED", "value": "As the seventh leading cause of death in the U.S., diabetes kills approximately 75,000 people a year (CDC FastStats 2015). Diabetes is a group of diseases marked by high blood glucose levels, resulting from the body's inability to produce or use insulin (CDC Statistics 2014, ADA Basics 2013). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney failure, amputation of toes, feet or legs, and premature death. (CDC Fact Sheet 2014). \n\nIn 2012, diabetes cost the U.S. an estimated $245 billion: $176 billion in direct medical costs and $69 billion in reduced productivity. This is a 41 percent increase from the estimated $174 billion spent on diabetes in 2007 (ADA Economic 2013). \n\nIn 2011, diabetes accounted for 44% of new kidney failure cases. In the same year, 49,677 diabetics started treatment for kidney failure and 228,924 people of all ages with kidney failure due to diabetes were living on chronic dialysis or with a kidney transplant (CDC Statistics, 2014).", "media_type": "text/plain" } }, { "code": "CRS", "value": "American Diabetes Association (2017):\n\nScreening\n- At least once a year, quantitatively assess urinary albumin (eg, spot urinary albumin-to-creatinine ratio [UACR]) and estimated glomerular filtration rate (eGFR) in patients with type 1 diabetes duration of greater than or equal to 5 years in all patients with type 2 diabetes, and in all patients with comorbid hypertension. (Level of evidence: B)\n\nTreatment\n- An angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) is not recommended for the primary prevention of diabetic kidney disease in patients with diabetes who have normal blood pressure, normal UACR (<30 mg/g), and normal estimated glomerular filtration rate. (Level of evidence: B)\n- Either an ACE inhibitor or ARB is suggested for the treatment of the nonpregnant patient with modestly elevated UACR (30-299 mg/day) (Level of evidence: C) and is strongly recommended for those with urinary albumin excretion >=300 mg/day. (Level of evidence: A)\n- When ACE inhibitors, ARBs, or diuretics are used, monitor serum creatinine and potassium levels for the development of increased creatinine or changes in potassium. (Level of evidence: E)\n- Continued monitoring of UACR in patients with albuminuria treated with an ACE inhibitor or ARBs is reasonable to assess progression of diabetic kidney disease. (Level of evidence: E)\n\nAmerican Association of Clinical Endocrinologists (2015): \n- Beginning 5 years after diagnosis in patients with type 1 diabetes (if diagnosed before age 30) or at diagnosis in patients with type 2 diabetes and those with type 1 diabetes diagnosed after age 30, annual assessment of serum creatinine to determine the estimated glomerular filtration rate (eGFR) and urine albumin excretion rate (AER) should be performed to identify, stage, and monitor progression of diabetic nephropathy (Grade C; best evidence level 3). \n- Patients with nephropathy should be counseled regarding the need for optimal glycemic control, blood pressure control, dyslipidemia control, and smoking cessation (Grade B; best evidence level 2). \n- In addition, they should have routine monitoring of albuminuria, kidney function electrolytes, and lipids (Grade B; best evidence level 2). \n- Associated conditions such as anemia and bone and mineral disorders should be assessed as kidney function declines (Grade D; best evidence level 4). \n- Referral to a nephrologist is recommended well before the need for renal replacement therapy (Grade D; best evidence level 4).", "name": "Clinical Recommendation Statement", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "CRS", "title": "Clinical Recommendation Statement" }, "value_obj": { "type": "ED", "value": "American Diabetes Association (2017):\n\nScreening\n- At least once a year, quantitatively assess urinary albumin (eg, spot urinary albumin-to-creatinine ratio [UACR]) and estimated glomerular filtration rate (eGFR) in patients with type 1 diabetes duration of greater than or equal to 5 years in all patients with type 2 diabetes, and in all patients with comorbid hypertension. (Level of evidence: B)\n\nTreatment\n- An angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) is not recommended for the primary prevention of diabetic kidney disease in patients with diabetes who have normal blood pressure, normal UACR (<30 mg/g), and normal estimated glomerular filtration rate. (Level of evidence: B)\n- Either an ACE inhibitor or ARB is suggested for the treatment of the nonpregnant patient with modestly elevated UACR (30-299 mg/day) (Level of evidence: C) and is strongly recommended for those with urinary albumin excretion >=300 mg/day. (Level of evidence: A)\n- When ACE inhibitors, ARBs, or diuretics are used, monitor serum creatinine and potassium levels for the development of increased creatinine or changes in potassium. (Level of evidence: E)\n- Continued monitoring of UACR in patients with albuminuria treated with an ACE inhibitor or ARBs is reasonable to assess progression of diabetic kidney disease. (Level of evidence: E)\n\nAmerican Association of Clinical Endocrinologists (2015): \n- Beginning 5 years after diagnosis in patients with type 1 diabetes (if diagnosed before age 30) or at diagnosis in patients with type 2 diabetes and those with type 1 diabetes diagnosed after age 30, annual assessment of serum creatinine to determine the estimated glomerular filtration rate (eGFR) and urine albumin excretion rate (AER) should be performed to identify, stage, and monitor progression of diabetic nephropathy (Grade C; best evidence level 3). \n- Patients with nephropathy should be counseled regarding the need for optimal glycemic control, blood pressure control, dyslipidemia control, and smoking cessation (Grade B; best evidence level 2). \n- In addition, they should have routine monitoring of albuminuria, kidney function electrolytes, and lipids (Grade B; best evidence level 2). \n- Associated conditions such as anemia and bone and mineral disorders should be assessed as kidney function declines (Grade D; best evidence level 4). \n- Referral to a nephrologist is recommended well before the need for renal replacement therapy (Grade D; best evidence level 4).", "media_type": "text/plain" } }, { "code": "IDUR", "value": "Higher score indicates better quality", "name": "Improvement Notation", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "IDUR", "title": "Improvement Notation" }, "value_obj": { "type": "ED", "value": "Higher score indicates better quality", "media_type": "text/plain" } }, { "code": "REF", "value": "American Diabetes Association. Microvascular complications and foot care. Sec. 10. In Standards of Medical Care in Diabetes-2017. Diabetes Care 2017;40(Suppl. 1):S88-S98.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "American Diabetes Association. Microvascular complications and foot care. Sec. 10. In Standards of Medical Care in Diabetes-2017. Diabetes Care 2017;40(Suppl. 1):S88-S98.", "media_type": "text/plain" } }, { "code": "REF", "value": "American Diabetes Association. 2013. Diabetes Basics. www.diabetes.org/diabetes-basics/?loc=GlobalNavDB.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "American Diabetes Association. 2013. Diabetes Basics. www.diabetes.org/diabetes-basics/?loc=GlobalNavDB.", "media_type": "text/plain" } }, { "code": "REF", "value": "American Diabetes Association (ADA). April 2013. Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care. Vol. 36 no. 4 \n1033-46. http://care.diabetesjournals.org/content/36/4/1033.full.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "American Diabetes Association (ADA). April 2013. Economic Costs of Diabetes in the U.S. in 2012. Diabetes Care. Vol. 36 no. 4 \n1033-46. http://care.diabetesjournals.org/content/36/4/1033.full.", "media_type": "text/plain" } }, { "code": "REF", "value": "Centers for Disease Control and Prevention (CDC). 2014. National Diabetes Statistics Report. \nhttp://www.cdc.gov/diabetes/pdfs/data/2014-report-estimates-of-diabetes-and-its-burden-in-the-united-states.pdf", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Centers for Disease Control and Prevention (CDC). 2014. National Diabetes Statistics Report. \nhttp://www.cdc.gov/diabetes/pdfs/data/2014-report-estimates-of-diabetes-and-its-burden-in-the-united-states.pdf", "media_type": "text/plain" } }, { "code": "REF", "value": "Centers for Disease Control and Prevention (CDC). 2015. FastStats: Deaths and Mortality. www.cdc.gov/nchs/fastats/deaths.htm.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Centers for Disease Control and Prevention (CDC). 2015. FastStats: Deaths and Mortality. www.cdc.gov/nchs/fastats/deaths.htm.", "media_type": "text/plain" } }, { "code": "REF", "value": "Centers for Disease Control and Prevention. 2014. CDC Features. Diabetes Latest. www.cdc.gov/features/diabetesfactsheet/.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Centers for Disease Control and Prevention. 2014. CDC Features. Diabetes Latest. www.cdc.gov/features/diabetesfactsheet/.", "media_type": "text/plain" } }, { "code": "REF", "value": "Handelsman Y, Bloomgarden ZT, Grunberger G, Umpierrez G, Zimmerman RS, Bailey TS, et al. (2015) American Association of Clinical Endocrinologists and American College of Endocrinology-Clinical Practice Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan-2015. Endocr Pract 21 Suppl 1: 1-87.", "name": "Reference", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "REF", "title": "Reference" }, "value_obj": { "type": "ED", "value": "Handelsman Y, Bloomgarden ZT, Grunberger G, Umpierrez G, Zimmerman RS, Bailey TS, et al. (2015) American Association of Clinical Endocrinologists and American College of Endocrinology-Clinical Practice Guidelines for Developing a Diabetes Mellitus Comprehensive Care Plan-2015. Endocr Pract 21 Suppl 1: 1-87.", "media_type": "text/plain" } }, { "code": "DEF", "value": "None", "name": "Definition", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "DEF", "title": "Definition" }, "value_obj": { "type": "ED", "value": "None", "media_type": "text/plain" } }, { "code": "GUIDE", "value": "Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included", "name": "Guidance", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "GUIDE", "title": "Guidance" }, "value_obj": { "type": "ED", "value": "Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included", "media_type": "text/plain" } }, { "code": "TRANF", "value": "TBD", "name": "Transmission Format", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "TRANF", "title": "Transmission Format" }, "value_obj": { "type": "ED", "value": "TBD", "media_type": "text/plain" } }, { "code": "IPOP", "value": "Patients 18-75 years of age with diabetes with a visit during the measurement period", "name": "Initial Population", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "IPOP", "title": "Initial Population" }, "value_obj": { "type": "ED", "value": "Patients 18-75 years of age with diabetes with a visit during the measurement period", "media_type": "text/plain" } }, { "code": "DENOM", "value": "Equals Initial Population", "name": "Denominator", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "DENOM", "title": "Denominator" }, "value_obj": { "type": "ED", "value": "Equals Initial Population", "media_type": "text/plain" } }, { "code": "DENEX", "value": "Exclude patients who were in hospice care during the measurement year", "name": "Denominator Exclusions", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "DENEX", "title": "Denominator Exclusions" }, "value_obj": { "type": "ED", "value": "Exclude patients who were in hospice care during the measurement year", "media_type": "text/plain" } }, { "code": "NUMER", "value": "Patients with a screening for nephropathy or evidence of nephropathy during the measurement period", "name": "Numerator", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "NUMER", "title": "Numerator" }, "value_obj": { "type": "ED", "value": "Patients with a screening for nephropathy or evidence of nephropathy during the measurement period", "media_type": "text/plain" } }, { "code": "NUMEX", "value": "Not Applicable", "name": "Numerator Exclusions", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "NUMEX", "title": "Numerator Exclusions" }, "value_obj": { "type": "ED", "value": "Not Applicable", "media_type": "text/plain" } }, { "code": "DENEXCEP", "value": "None", "name": "Denominator Exceptions", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "DENEXCEP", "title": "Denominator Exceptions" }, "value_obj": { "type": "ED", "value": "None", "media_type": "text/plain" } }, { "code": "SDE", "value": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex", "name": "Supplemental Data Elements", "code_obj": { "type": "CD", "system": "2.16.840.1.113883.5.4", "code": "SDE", "title": "Supplemental Data Elements" }, "value_obj": { "type": "ED", "value": "For every patient evaluated by this measure also identify payer, race, ethnicity and sex", "media_type": "text/plain" } } ], "measure_period": { "type": "IVL_TS", "low": { "type": "TS", "value": "201201010000", "inclusive?": true, "derived?": false }, "high": { "type": "TS", "value": "201212312359", "inclusive?": true, "derived?": false }, "width": { "type": "PQ", "unit": "a", "value": "1", "inclusive?": true, "derived?": false } }, "measure_scoring": "PROPORTION", "population_criteria": { "IPP": { "conjunction?": true, "type": "IPP", "hqmf_id": "6CD39B4B-16E6-4FD4-9241-527F9F4A48D0", "preconditions": [ { "id": 2, "preconditions": [ { "id": 1, "reference": "DiabetesMedicalAttentionforNephropathy__Initial_Population__D9836559_E946_49E8_A122_0B0C13F9770B" } ], "conjunction_code": "allTrue" } ] }, "DENOM": { "conjunction?": true, "type": "DENOM", "hqmf_id": "B735F4BD-DFAE-45E3-BAA9-E09BDF731B8E", "preconditions": [ { "id": 4, "preconditions": [ { "id": 3, "reference": "DiabetesMedicalAttentionforNephropathy__Denominator__D9836559_E946_49E8_A122_0B0C13F9770B" } ], "conjunction_code": "allTrue" } ] }, "NUMER": { "conjunction?": true, "type": "NUMER", "hqmf_id": "ECFD4C68-90F8-4143-8298-21798069AE8E", "preconditions": [ { "id": 6, "preconditions": [ { "id": 5, "reference": "DiabetesMedicalAttentionforNephropathy__Numerator__D9836559_E946_49E8_A122_0B0C13F9770B" } ], "conjunction_code": "allTrue" } ] }, "DENEX": { "conjunction?": true, "type": "DENEX", "hqmf_id": "F82CC93D-C1A2-4E10-A087-81D666395C48", "preconditions": [ { "id": 8, "preconditions": [ { "id": 7, "reference": "DiabetesMedicalAttentionforNephropathy__Denominator_Exclusions__D9836559_E946_49E8_A122_0B0C13F9770B" } ], "conjunction_code": "atLeastOneTrue" } ] } }, "population_sets": [ { "population_set_id": "PopulationCriteria1", "populations": { "DENEX": { "hqmf_id": "F82CC93D-C1A2-4E10-A087-81D666395C48", "library_name": "DiabetesMedicalAttentionforNephropathy", "statement_name": "Denominator Exclusions" }, "DENOM": { "hqmf_id": "B735F4BD-DFAE-45E3-BAA9-E09BDF731B8E", "library_name": "DiabetesMedicalAttentionforNephropathy", "statement_name": "Denominator" }, "IPP": { "hqmf_id": "6CD39B4B-16E6-4FD4-9241-527F9F4A48D0", "library_name": "DiabetesMedicalAttentionforNephropathy", "statement_name": "Initial Population" }, "NUMER": { "hqmf_id": "ECFD4C68-90F8-4143-8298-21798069AE8E", "library_name": "DiabetesMedicalAttentionforNephropathy", "statement_name": "Numerator" }, "_type": "CQM::ProportionPopulationMap" }, "title": "Population Criteria Section" } ], "source_data_criteria": [ { "admissionSource": null, "authorDatetime": null, "codeListId": "2.16.840.1.113883.3.464.1003.101.12.1048", "dataElementCodes": [ ], "description": "Encounter, Performed: Face-to-FaceInteraction", "diagnoses": null, "dischargeDisposition": null, "facilityLocations": [ ], "hqmfOid": "2.16.840.1.113883.10.20.28.4.5", "id": "5d289cbc31fe5f8b4f7742a5", "lengthOfStay": null, "negationRationale": null, "participant": null, "priority": null, "qdmCategory": "encounter", "qdmStatus": "performed", "qdmTitle": "Encounter, Performed", "qdmVersion": "5.5", "relevantPeriod": null, "_type": "QDM::EncounterPerformed" }, { "anatomicalLocationSite": null, "authorDatetime": null, "codeListId": "2.16.840.1.113883.3.464.1003.109.12.1013", "components": null, "dataElementCodes": [ ], "description": "Procedure, Performed: DialysisServices", "hqmfOid": "2.16.840.1.113883.10.20.28.4.67", "id": "5d289cbc31fe5f8b4f7742a6", "incisionDatetime": null, "method": null, "negationRationale": null, "performer": null, "priority": null, "qdmCategory": "procedure", "qdmStatus": "performed", "qdmTitle": "Procedure, Performed", "qdmVersion": "5.5", "rank": null, "reason": null, "relevantDatetime": null, "relevantPeriod": null, "result": null, "status": null, "_type": "QDM::ProcedurePerformed" }, { "anatomicalLocationSite": null, "authorDatetime": null, "codeListId": "2.16.840.1.113883.3.464.1003.109.12.1012", "components": null, "dataElementCodes": [ ], "description": "Procedure, Performed: KidneyTransplant", "hqmfOid": "2.16.840.1.113883.10.20.28.4.67", "id": "5d289cbc31fe5f8b4f7742a7", "incisionDatetime": null, "method": null, "negationRationale": null, "performer": null, "priority": null, "qdmCategory": "procedure", "qdmStatus": "performed", "qdmTitle": "Procedure, Performed", "qdmVersion": "5.5", "rank": null, "reason": null, "relevantDatetime": null, "relevantPeriod": null, "result": null, "status": null, "_type": "QDM::ProcedurePerformed" }, { "codeListId": "2.16.840.1.113762.1.4.1", "dataElementCodes": [ ], "description": "Patient Characteristic Sex: ONCAdministrativeSex", "hqmfOid": "2.16.840.1.113883.10.20.28.4.55", "id": "5d289cbc31fe5f8b4f7742a8", "qdmCategory": "patient_characteristic", "qdmStatus": "gender", "qdmTitle": "Patient Characteristic Sex", "qdmVersion": "5.5", "_type": "QDM::PatientCharacteristicSex" }, { "admissionSource": null, "authorDatetime": null, "codeListId": "2.16.840.1.113883.3.464.1003.109.12.1014", "dataElementCodes": [ ], "description": "Encounter, Performed: ESRDMonthlyOutpatientServices", "diagnoses": null, "dischargeDisposition": null, "facilityLocations": [ ], "hqmfOid": "2.16.840.1.113883.10.20.28.4.5", "id": "5d289cbc31fe5f8b4f7742a9", "lengthOfStay": null, "negationRationale": null, "participant": null, "priority": null, 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"qdmVersion": "5.5", "qrdaOid": "2.16.840.1.113883.10.20.24.3.135", "recorder": null, "severity": null, "_type": "QDM::Diagnosis" }, { "admissionSource": null, "authorDatetime": null, "codeListId": "2.16.840.1.113883.3.464.1003.101.12.1025", "dataElementCodes": [ ], "description": "Encounter, Performed: PreventiveCareServices-EstablishedOfficeVisit18andUp", "diagnoses": null, "dischargeDisposition": null, "facilityLocations": [ ], "hqmfOid": "2.16.840.1.113883.10.20.28.4.5", "id": "5d289cbc31fe5f8b4f7742ac", "lengthOfStay": null, "negationRationale": null, "participant": null, "priority": null, "qdmCategory": "encounter", "qdmStatus": "performed", "qdmTitle": "Encounter, Performed", "qdmVersion": "5.5", "relevantPeriod": null, "_type": "QDM::EncounterPerformed" }, { "anatomicalLocationSite": null, "authorDatetime": null, "codeListId": "2.16.840.1.113883.3.464.1003.109.12.1004", "dataElementCodes": [ ], "description": "Diagnosis: DiabeticNephropathy", "hqmfOid": 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